MEDICARE: MR. THANH D MAI B.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RPH 38601	CA

General Provider Information

NPI Number	:	1083935175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THANH D MAI B.S

Provider Business Mailing Address
First Line	:	8051 CENTERSTONE DR
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92646-8572
Country	:	US
Telephone Number	:	714-717-8291
Fax Number	:

Provider Business Practice Location Address
First Line	:	8051 CENTERSTONE DR
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92646-8572
Country	:	US
Telephone Number	:	714-717-8291
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2010
Last Update Date	:	06/12/2010

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